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[IP] My appeal letter to BC/BS of Michigan (kinda long)
I've written my letter that I will submit to BC/BS of Michigan to appeal
their payment for only 200 test strips rather than the 300 strips my endo
and I think I should have each month. I think I've covered all the bases,
but am open for any suggestions. Thanks!
RoseLea (armed and fighting)
>I am appealing the partial payment I received for Glucose Test Strips. I
>submitted a receipt along with my doctor's prescription and Letter of
>Medical Necessity for 300 strips for one month. The total cost of these
>supplies was $206.97 (3 boxes of 100 strips at $68.99 each). I received a
>check for $154.72. When I contacted your phone representative, I was told
>that Blue Cross had a limit set of only 200 test strips per month and the
>claim was paid on the maximum cost for 200 strips.
>In March of this year, the State of Michigan passed Public Act 424, which
>requires that certain diabetic prescription drugs, supplies and equipment
>become a covered benefit. These benefits must be medically necessary and
>prescribed by an M.D. or a D.O. Test strips are one of these diabetic
>supplies covered under Public Act 424.
>I am an insulin-dependent, Type 1 diabetic, on an insulin pump. I need to
>test frequently during the day to make sure that my dosage of insulin is
>correct to cover the carbohydrates that I've eaten each day and to ensure
>that my blood glucose level is as close to the normal range as possible.
>My doctor and I both agree that by keeping my glucose levels in the normal
>range will aid in preventing me from having future complications of diabetes.
>The Diabetes Control and Complications Trial supports this treatment
>regimen. This study was sponsored by the National Institute of Health and
>ran for a period of 10 years, from 1983 through 1993. 1,441 volunteers
>with Type 1 diabetes participated in this study. The study found that with
>keeping blood glucose levels more in the normal range each day resulted in
>better diabetes control and lowered the amount and severity of diabetes
>I am enclosing my paperwork for this claim, including my doctor's
>prescription form and Letter of Medical Necessity (which I include with
>every claim I submit to Blue Cross and Blue Shield of Michigan). Thank you.
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